Specialty Profiles

What TV gets wrong about forensic pathology

There is a shortage of real forensic pathologists. For many years there’s been no problem running into fictional ones who portray a false idea of life in the medical specialty and the real-life limitations of this branch of forensic science.

Starting in 2000, “CSI: Crime Scene Investigation” ran 15 seasons—337 episodes—not counting its spinoffs. Add to that hundreds of more hours of forensic dramas in CSI’s wake, such as “Crossing Jordan,” “Bones” and “Body of Proof.” Unlike the victims in their stories, the shows can live on forever thanks to streaming and syndication.

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What it’s like to specialize in forensic pathology: Shadowing Dr. Melinek

No wonder so many people think they understand the medical practice of determining cause of death. Except they don’t, particularly if they think a medical examiner’s time is spent mostly on murder.

“The reality is that only about 10 percent of our cases are suspicious deaths or homicides,” said board-certified forensic pathologist Judy Melinek, MD. “The remaining 90 percent encompasses natural deaths, accidents and suicides as well as a few undetermined.”

Figuring all that out is seldom a star turn. “Typically, in order to simplify plotlines, they have a single character doing a lot of work and knowing a lot of stuff that, in reality, multiple consultants or people would be doing,” she said. And it’s those same actors who get to go out on location. It’s common that a real-life forensic pathologist might get out to a crime scene only once or twice a month.

Dr. Melinek practices forensic pathology in the San Francisco area as a government contractor, private consultant and expert witness. She is also a New York Times best-selling author, with her co-author husband, of the memoir, Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner.

“I wanted to write the book, in part, because of all the TV shows that are out there, misrepresenting what we actually do,” Dr. Melinek said.

Exaggerated use of high tech

Forensic pathology is hardly boring—especially as Dr. Melinek is describes it—but can be more basic than scriptwriters imagine it to be.

“Most cases that go to court are relatively straightforward and do not require the kind of technology that CSI assumes—or pretends—exists in the real world,” said Brian L. Peterson, MD, chief medical examiner for Milwaukee County in Wisconsin. When the case isn’t a whodunit, but rather a who-was-it, a DNA kit typically isn’t needed.

“We usually identify decedents based on fingerprints or dental comparison, when necessary, and not DNA,” Dr. Peterson said.

Dr. Melinek took aim, in her Forensic Pathology Forum blog, at other scriptwriter liberties. The lighting in the lab is too low, passions between co-workers too high, test results are unrealistically quick to appear, and investigators are slow to leave the office at quitting time. On that last point, she underscores that one of the selling points of the specialty is that it is nine-to-five work. 

Not that many physicians, for now at least, will have firsthand experience with the relatively manageable work-life balance in forensic pathology.

“We have about half as many forensic pathologists as we need in the United States. It's a real crisis,” said Dr. Melinek. “There is a certain amount of glamor associated with the job with regards to the public perception of forensics, but not in medicine.”

“CSI effect” debunked

If Hollywood gets forensic pathology wrong, at least they cannot be blamed for the so-called CSI effect. The speculation—now widely debunked—was that the public’s exaggerated expectations about the role forensic science was showing up in jury boxes and significantly influencing verdicts.

“The ‘CSI effect’ has been discussed from the podium” at meetings of the National Association of Medical Examiners,” said Dr. Peterson, who serves as NAME’s board chair. “Fortunately, the presentations tend to be of the ‘here was my one experience’ variety, and have never indicated a growing trend.”

On the witness stand, Dr. Peterson has his own script to help lead jurors back to reality. “I tend to follow up an ‘I don’t know’ response by adding that ‘given current science, it is simply not knowable, and here’s why’ to help jurors understand more clearly.”